Fetal alcohol spectrum disorders are a group of diagnoses that are incredibly misunderstood and often misidentified. Speech-language pathologists (SLP) are the key to identification and intervention for clients with FASD.
FASD is everywhere. I can almost guarantee that the vast majority of SLPs with more than 20 people on their caseloads have at least 1 person that would meet the criteria for FASD. Not only is it the leading cause of developmental disabilities worldwide, but it also has a conservative prevalence of 1 in 20. Currently, fewer than 1% of SLP clients receive an accurate diagnosis.
FASD gets left out of the conversation of neurodevelopmental disorders (NDD). A lot. In fact, the DSM-5 only mentions FASD in two places: one is at the end of the NDD chapter under “other specified neurodevelopmental disorders” and the other is under “topics for further review.” If you research articles discussing NDDs, you will notice how infrequently FASD is mentioned. If we’re going to make progress with FASD research, we must change the conversation.
People with FASD may not qualify for services on your go-to assessments. Think outside of the box. You must be willing to dig further than only assessment in language or articulation. If you evaluate cognitive skills like executive function, you are more likely to find areas of need that impact daily living.
Strengths-Based isn’t the only answer…but it’s a great starting point. Beyond accounting for strengths, build your plan of care around your client’s motivations and passions. For example, I’m great at cleaning dishes, but that doesn’t make me want to do kitchen duty.
People with FASD are the experts of their lives. Get to know your clients and families. They often want to share their knowledge. Putting together research on FASD? Talk to a person with lived experience before you start. Thinking of building a diagnostic clinic? Ask a person living with FASD what they want practitioners to know.
Adults with FASD want services too. If you’re a person who sees both children and adults, open your practice to support clients with FASD transitioning to adulthood. Many adults with FASD who would like help with everyday executive function tasks. And here’s an extra tip: people with FASD excel with peer mentors, and as peer mentors.
FASD “behaviors” are symptoms of a developmental disability. If you approach symptoms of FASD (e.g., dysregulation, memory issues, social challenges) with patience and understanding, you will make more progress with your clients. It’s important to teach families, caregivers, and teachers how to implement this also. Therapy that’s integrated in the classroom often works REALLY well with this population.
The “supports paradigm” needs to include the entire family. Both individuals with FASD and their families may need support. Consider including family members in your sessions. Family education is essential to client success. You can help your clients’ families learn how to support their loved ones in areas like executive function and self-regulation.
And finally SLPs are the perfect professionals to work with patients and clients with FASD. After all, FASD is a cognitive-communication disorder often characterized by symptoms in cognition, language, and pragmatics. And co-occurring conditions are often associated with the Big Nine areas from ASHA. Who better to identify and build lifelong supports for people with FASD than SLPs?
Elizabeth Cleveland, Ph.D.
Executive Director of the Specialty Diagnostic Resource Center, Associate Director for Partners for Inclusive Communities, Director of Training for Arkansas LEND
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